Lim Anthony M, Ghazaleh Jonathan R, Cacdac Robert M, Oberndorf Julia K, Quizon Marrey Ruby L, Thomas Justin M
Eisenhower Medical Center, 39000 Bob Hope Drive, Rancho Mirage, CA 92270, USA.
Case Rep Crit Care. 2023 Aug 29;2023:9916937. doi: 10.1155/2023/9916937. eCollection 2023.
Secondary hemophagocytic lymphohistiocytosis (HLH) is an elusive entity with sequelae that may be confused with sepsis. We discuss a 45-year-old man with decompensated liver cirrhosis with sepsis treated with broad-spectrum intravenous antibiotics. Further work-up initially supported sepsis-HLH overlap syndrome (SHLHOS) and corticosteroids were added. Ongoing refractory hypotension ensued, and the patient passed within 31 hours of presentation. Based on the patient's overwhelming immune activation and clinical course likely unsalvageable by cytotoxic immunosuppressive agents, the patient was diagnosed with sepsis with acute end organ dysfunction. This case report illustrates both the diagnostic challenge of sepsis versus HLH, which both require very different treatments, and the potential for rapid clinical decline without swift recognition and management of the true pathology.
继发性噬血细胞性淋巴组织细胞增生症（HLH）是一种难以捉摸的病症，其后遗症可能与败血症相混淆。我们讨论了一名45岁失代偿期肝硬化合并败血症的男性患者，接受了广谱静脉抗生素治疗。进一步检查最初支持败血症-HLH重叠综合征（SHLHOS），并加用了皮质类固醇。随后出现持续难治性低血压，患者在就诊后31小时内死亡。基于患者压倒性的免疫激活以及细胞毒性免疫抑制剂可能无法挽救的临床病程，该患者被诊断为伴有急性终末器官功能障碍的败血症。本病例报告既说明了败血症与HLH的诊断挑战（两者需要截然不同的治疗方法），也说明了如果不能迅速识别和处理真正的病理情况，临床病情可能会迅速恶化。
